Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | DO150752 | OR |
NPI | 1134235930 |
---|---|
Provider Name | Dr. Jason G Anderson |
First Address | Tualatin, OR 97062-9999 |
Second Address | Tualatin, OR 97062-9999 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 23/02/2015 |